Send to: G3 Global Services ort Department SAN FRANCISCO reet, Suite 1520 ae : SECOND VALID PASSPORT SanFrancisco®g3visas.com Your invoice will be sent to your contact emaal. J Check here if you require a hard copy included vetth your retum delivery. Payment Information : i" | [Payment Via Check #: iM! Payrnent Via Credit Card: Visa/MasterCard: 5474-15 13.7308.9256 ad Concierge Servico Requestes Exp. Date:_'' 19 Security Code: 3 5 7 oR American Express: “ Total Fees trom Applicable Fees Page Exp. Date: /___ Security Code: Name as it appears on the card: FEE # Travelers TOTAL K Concierge Fee $175.00 X $175.00 Sabet ain US Government Fee $170.00 X $170.00 Billing Address: 575 Lexington Ave, 4th Floor G3 Service Fee $275.00 X $275.00 City: NY State NY Zip: 10022 Passport Protection Plan $40.00 X $40.00 Return Delivery Fee $84.00 Signature: Subtotal $744.00 Add 5% for credit card convenience fee $37.20 Payment Via Approved Billing Terms 63 Customer Number, Billing, P.0., Project or Reference Codet Totel Payment Enciosed | 6781.20 Traveler Information Traveler 1 Name: Jeffrey Epstein Date of Bath: 01/20/1953 Traveler 2 Name: Date of Birth: Passport Service Vaid (Book and Card) Processing Speed: = Mission Critical Priority Travel Detaiis Date of US Departure: ANTICIPATED 06/__/2016 | must have my passport nolaterthan: ggy _/2016 Other visa or passport services requested: Notes: Contact Information Name: Darren Indyke a Daytime Phone: Z Return Delivery Address Name: Darren Indyke Company: Darren K. Indyke, PLLC Sweet Address: 575 Lexington, 4th Floor keane State: yy Zip Code: 19922 Mobile Phone: 1S = PAGE 4 REV EFTA00314137